Transcript Slide 1

Relative Value Units,
Coding Overview and
Data Quality Implications
Lt Col Jeanne Yoder
Program Manger, Uniform Business Office
RHIA, CCS-P, CPC
Aug/Sep 2005
Jeanne’s Moto
• You give me bad data, I’ll make bad
decisions
Objectives
• Have a Vague Idea of Data Collection and
Measurement Tools
• Had a Look-See of a CMS and MHS RVU
table
• Understand that the Incorrect Application
of Tools will Drive Really Bad Decisions
Glossary of Terms
• Coding Systems
– ICD – International Classification of Diseases
– CPT – Current Procedural Terminology
– HCPCS – Healthcare Common Procedure
Coding System
• Work Measurement Systems
– RVU - Relative Value Units
– RWP - Relative Weighted Products
Glossary of Terms
• Organizations
– CMS – Center for Medicare and Medicaid
Services
– MHS – Military Health System
• Initiative
– IBWA – Industry Based Workload Alignment
• Groupings
– DRG – Diagnosis Related Group
– APC – Ambulatory Payment Classification
Glossary of Terms
• RVU Cats and Dogs
– Mod - Modifier
– Non-Fac - Non-facility (not associated with a
hospital, e.g., clinic down the street)
– PE – Practice Expense
– MP – Malpractice
• Other Cats and Dogs
– BOHICA
– SWAG
– WAGNER
Data Collection Tools
• ICD-9-CM
• HCPCS
– CPT (Level 1 HCPCS)
• E&M
• Other Procedures
• Anesthesia – uses base units, not RVUs
– HCPCS (Level 2 HCPCS)
• Non-provider services
• Supplies/equipment
ICD-9-CM
• Diagnoses
• Factors Influencing Health
• External Causes of Injury
– STANAG – Standard NATO Injury (not ICD, but an
injury classification system currently used for
inpatient)
• Inpatient Institutional Non-Professional
Procedure Component
• Diagnosis Related Groups – Dx + procedure
Professional vs Institutional
• Professional
– Work – work done by a privileged provider
– Practice Expense - work done by a privileged
provider’s “practice”
• Nurses, technicians, office space
• Institutional
– Services provided by entity other than the
provider’s “practice”
– Inpatient (hospital), ER, observation, APV, lab,
radiology
CPT
(Current Procedural Terminology)
• Evaluation and Management – when a
provider obtains data, makes and
assessment and develops a treatment
plan without doing a “procedure”; an office
visit or round
• Procedures
– Anesthesia
– Surgical
– Medical
CPT
• Laboratory and Radiology
– Not included in SADR feed to the Clinical
Data Repository (CDR) of which the MHS
Mart (M2) is a subset
– Working on a feed, called the A-SADR,
meaning “Ancillary SADR”
• Ancillary only meaning lab and rad, not physical
therapy and occupational therapy (those are B
MEPRS and go up in the SADR)
CPT
• Category II – used to track HEDIS things
– xxxxF
– 0500F – initial prenatal care (to see if done in
first trimester)
• Category III – emerging technology
– xxxxT
– 0017T – destruction of macular drusen,
photocoagulation
HCPCS
•
•
•
•
•
•
•
•
A=ambulance (and some cats and dogs)
C=pass-through, can bill in addition to APC
D=dental
E= durable equipment (e.g., crutches)
G=screenings, trimming toe nails
L=prosthetics
Q=all kinds of neat stuff
S=lots of training , LASIK, PRK, physical exams
for college…
• V=vision and hearing
Measurement Tools
•
•
•
•
Money
Hours/Full time equivalents
RVUs
RWPs
MEPRS
• Money should be reflected in MEPRS
• Full time equivalents should be reflected
MEPRS
Relative Value Units are:
• A way to compare resources used to
produce a product
• Examples of products are:
– Office visits
– Excision of a lesion
– Delivering a baby
Birth of an RVU
• RVUs are Professional and Practice Expenses
associated with a Professional Service
• Provider-patient interaction (usually)
• Documented
• Coded with a
– Current Procedural Terminology (CPT)
• Evaluation and Management (E&M)
• Surgical Procedure
• Other Procedure
– Healthcare Common Procedural Coding System (HCPCS)
• Not all, many are durable equipment or supplies
• Look up the code in the RVU table
2004 UBU-UBO Conference
Example
• Patient seen in ER after getting in a fight
with a Thanksgiving Turkey
• ER doctor documents ER visit to include 4
stitches in palm of left hand and tetanus
shot
• Coded with 99282-25, 12002-LT, 90703,
90471
• Then in yellow is same encounter in the
doctor’s office
Example – RVU (Professional)
FULLY
FULLY
implemented
HCPCS
DESCRIPTION
FULLY
FULLY
implemented
implemented
NON-FAC*
implemented
FACILITY **
WORK NON-FAC
NA
facility
NA
MP
non-facility
facility
RVU
indicator
PE RVU
indicator
RVU
TOTAL
TOTAL
PE RVU
99282 Emergency dept visit
12002 Repair superficial wound(s)
90703 Tetanus vaccine, im
90471 Immunization admin
SUM OF PROFESSIONAL AT ER
0.55
1.86
0.00
0.17
2.58
0.14 NA
2.04
0.00
0.31
0.14
0.90
0.00
0.31 NA
1.35
0.04
0.18
0.00
0.01
0.23
0.73
4.08
0.00
0.49
0.73
2.94
0.00
0.49
4.16
99213 Office/outpatient visit, est
SUM OF PROFESSIONAL AT OFFICE
0.67
2.70
0.69
3.04
0.24
0.03
0.22
1.39
5.96
0.94
*would not do in a doctor's office
**would only do in a doctor's office, if done elsewhwere, part of the institutional
Done in doctors office = $37.89 x 5.96 = $225.82
Done in ER, professional bill is = $37.89 x 4.16 = $157.62
Relative Value Units Are Only Part of What Is
Done By Providers In Our MTFs
• Lots of what is done is not “codable”
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Hall way consults
Effectiveness reports/civilian appraisals
Extra time spent consoling a bereaved patient
Shoveling snow/picking up debris after hurricanes/tornados
Discussing an AD mental health with his/her Commander
Participating on MEBs
Reviewing and returning consults for more info
Reviewing charts only to have the patient no show
Waivers/PHA/pre- and post deployment briefs
Quality assurance (over reading EKGs)
Preparing and giving talks at grand rounds
Medical inprocessing
Overseas clearances
ADAPT
Relative Value Units Are Only Part of What Is
Done
• Lots of what is done may be “codable” but that doesn’t
mean there are RVUs
– E-mail
– Signing forms for insurance/handicapped parking
– Prenatal/diabetic/cardiac rehab/tobacco cessation
teaching
– Photorefractive keratectomy (PRK)
– SARC
– Tattoo removal using laser
Relative Value Units Are Not Just in the B
MEPRS
•
•
•
•
Inpatient surgeries/rounds
Inpatient care “downtown”
Treadmills
Telemedicine (particularly store and
forward)
• Work you do manning assist (it is in
someone else’s B MEPRS) – but you get
the other guy’s work in yours
Relative Value Units Are Only Part of What Is
Done
• Some may have RVUs in one RVU
system, but not in another
– Telephone consults (MHS has)
– Obstetrical codes (CMS has all in 594xx, MHS
has some; CMS doesn’t for
0500F/0501F/0502F/0503F, MHS has RVUs)
– Psychological testing (not in CMS, but in
MHS)
Relative Value Units
• Multiple RVU systems
– MHS
•
•
•
•
Work RVUs, EAS IV RVUs
Simple, Adjusted
PPS Work RVU, PPS Facility RVU
Individual Work RVU, Organizational Work RVU
– CMS
• Work RVUs
• Practice Expense RVUs
• Malpractice RVUs
– Ingenix
RVUs depend on where you look
• Worldwide Workload Report (WWR) and Medical
Expense and Performance Reporting System
(MEPRS)
• Only “count” visits
• Common “non-counts” in B (outpatient clinic) MEPRS are:
– Nurse/tech encounters
– Some telemedicine
– Reading EKGs
• RVUs in non-B MEPRS
– A-MEPRS – inpatient surgeries, rounds
– C-Dental
– D-Lab and radiology professional components, anesthesia base units,
EKGs
– F-Immunizations; Hearing Conservation; civilian hospital and VA
hospital rounds, surgeries, procedures
RVUs depend on where you look
• Standard Ambulatory Data Record (SADR)
– Feed from the Ambulatory Data Record (created in
the Ambulatory Data Module of CHCS and a feed
from CHCSII goes to the ADM in CHCS to create
the various feeds, such as the SADR and the
Third Party Outpatient Collection System)
– Does not include
• Quantities (two breaks in the same bone, multiples of
time sensitive codes such as psychologic testing…)
• Modifiers (bilateral, postoperative care only…)
RVUs depend on where you look
• ALL MHS professional services are
collected in the ADM, and found on your
server
– A subset forms the SADR, which is what HQ
uses
– A subset forms the TPOCS feed, which is
what billing uses
– BUT, how do you use this to compare to other
MTFs?
RVUs are NOT part of the RWP
• RVUs are NOT a reflection of inpatient
nursing/technician/facility costs
– Those are Relative Weighted Products (RWP)
– Each Diagnosis Related Group (DRG) has an
RWP
• Professional services (i.e., doctors’ rounds
and procedures for inpatients) are not part
of an RWP
DRG RWPs
DRG TITLE
DRGV22
1
2
3
370
371
372
373
374
375
504
505
506
507
508
509
510
511
512
513
CRANIOTOMY AGE >17 W CC
CRANIOTOMY AGE >17 W/O CC
CRANIOTOMY AGE 0-17
CESAREAN SECTION W CC
CESAREAN SECTION W/O CC
VAGINAL DELIVERY W COMPLICATING DIAGNOSES
VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES
VAGINAL DELIVERY W STERILIZATION &/OR D&C
VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C
EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/SKIN GFT
EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/O SKIN GFT
FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG
TRAUMA
FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG
TRAUMA
FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG
TRAUMA
FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG
TRAUMA
NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA
NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA
SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT
PANCREAS TRANSPLANT
RELATIVE
WEIGHTS
3.3344
1.9467
1.9767
0.8981
0.6221
0.5460
0.3601
0.6642
0.5810
13.0063
1.8727
4.0604
1.8618
1.3358
0.6859
1.2739
0.7058
6.0202
6.3212
RVUs are NOT part of the RWP
• Billing. In the MHS, we take the DRG
price, add 4% (based on MEPRS portion
of A-MEPRS collected from privileged
providers) and bill the professional
component with the institutional DRG
– Because, most MTFs aren’t even close in
coding professional inpatient services so we
would not know what to bill
• BOTTOM LINE: Have folks record
MEPRS properly!!!
MHS Unique RVUs
• From the RVU table, for all global procedures
having a 10 or 90 day post operative period,
multiply the intraoperative portion by the “work”
RVU – this is called “Global Surgical Adjusted”
• Provider Specialty Code 000-904, does not
include Provider Specialty Codes for “clinics”
• Multiple physicians = both receive credit for PPS
work and Organizational
• Count/non-count not a consideration
MHS Unique RVUs
• Use Ingenix table adjusted for MHS
• Health Care Summary Record RVU weight
table in the MDR
• Uses all MEPRS
MHS Unique RVUs - Simple
• Sum of “global surgical adjusted”
Physician work RVUs without discounting.
100% of sum of all the weights.
• 1st E&M (notice, not 2nd, or 3rd as not in
feed)
• 1, 2, 3, 4 Procedure (notice, not modifiers
or quantities or 5th, 6th… as not in feed)
MHS Unique RVUs - Adjusted
• Not using “global surgical adjusted” –
using the full CPT RVU for a procedure
with a 10 or 90 day post operative period
• 100% of the highest weighted item, 50% of
each additional procedure
MHS Unique RVUs –
PPS/Individual/Organizational
• E&M not included if there is a procedure
unless:
– Procedures are on list of approximately 150
minor procedures for which CMS allows credit
in conjunction with the E&M
– Procedure codes with E&M are ALL HCPCS
level II or begin with “9”
MHS Unique RVUs – PPS Work
RVU
• Use “global surgical adjusted” Physician work
RVU without discounting
• 100% of all weights, summed
• Sum x # of physicians on the record (based on
provider specialty code)
– Can’t use M2 as only primary provider on record
– Must pull from MDR
• Used by MHS to allocate funding for ambulatory
care
MHS Unique RVUs – PPS Facility
RVU
• Use “global surgical adjusted” Non-facility
practice expense RVU without discounting
• 100% of all weights, summed
• Used by MHS to allocate funding for
facility burden of care
MHS Unique RVUs – Individual
Work RVU
• Use “global surgical adjusted” Physician
Work RVU with discounting
• 100% of highest weighted RVU and 50%
of remaining RVUs, summed
• Tallies production for a single provider
MHS Unique RVUs –
Organizational Work RVU
• Use “global surgical adjusted” Physician work
RVU with discounting
• 100% of highest weight RVU and 50% of
remaining RVUs, summed
• Multiply by number of physicians based on
provider specialty code
– Must use MDR as SADR only has the primary
provider
• Tallies production workload for a clinic or higher
Examples
HCPCS
99201
99202
99203
99204
99205
MO Work
EAS IV
D
RVUS RVUS
00
0.45
0.95
00
0.88
1.67
00
1.34
2.47
00
2.00
3.51
00
2.67
4.47
30 CHARACTER DESC
OFFICE/OUTPATIENT VISIT, NEW
OFFICE/OUTPATIENT VISIT, NEW
OFFICE/OUTPATIENT VISIT, NEW
OFFICE/OUTPATIENT VISIT, NEW
OFFICE/OUTPATIENT VISIT, NEW
FULLY
HCPCS MOD DESCRIPTION
99201
99202
99203
99204
99205
Office/outpatient visit, new
Office/outpatient visit, new
Office/outpatient visit, new
Office/outpatient visit, new
Office/outpatient visit, new
FULLY
FULLY
FULLY
IMPLEMENTEDIMPLEMENTED
IMPLEMENTEDIMPLEMENTED
WORK
NON-FAC
FACILITY
MP
NON-FACILITYFACILITY
RVU
PE RVU
PE RVU
RVU
TOTAL
0.45
0.88
1.34
2.00
2.67
0.50
0.79
1.13
1.51
1.80
0.16
0.32
0.48
0.71
0.95
0.02
0.06
0.10
0.12
0.14
TOTAL
0.97
1.73
2.57
3.63
4.61
0.63
1.26
1.92
2.83
3.76
Which RVU to Use
• TMA Prospective Payment System
– MHS RVUs
– Compensated for lack of modifiers, quantities,
multiple providers
• AF BDQAS
– CMS, fully implemented non-facility total
• Compare to Civilian Sector
– CMS or Ingenix
Relative Value Units - CMS
• http://www.cms.hhs.gov/providers/pufdownload/rv
udown.asp
• Download the CY 2005 in .ZIP (requires UNZip
software)
• RVU05A_R.zip 1.6MB zip file -- Requires UNZIP
software -- 2005 revision file -- The revision
includes the changes identified in the forthcoming
CR3595.
• These are not the MHS RVUs
• Send me an e-mail and I’ll send you the 4MB file
of MHS RVUs
2004 UBU-UBO Conference
CMS RVU Table
1. Work – physician/privileged provider time
2. Non-facility Practice Expense – building,
equipment, nurses, techs
3. Facility Practice Expense – nurses, techs
4. Malpractice – malpractice
5. Non-facility Total – Work + Non-Fac PE +
Malpractice
6. Facility Total – Work + Fac PE +
Malpractice
• Fac Tot = “25 RVU/day”
• Non-Fac Tot = used for billing
2004 UBU-UBO Conference
2004 National Physician Fee Schedule Relative Value File
CPT codes and descriptions only are copyright 2003 AMA. All Rights Reserved. Applicable FARS/DFARS Apply.
Dental codes (D
Dental
codes)
codes
are copyright
(D codes)2002
are copyright
ADA. All 2002
Rights
ADA.
Reserved.
All Rights Reserved.
NOT USED
FULLY
FOR
REVISED 5/07/2004
HCPCS
MOD DESCRIPTION
93510
Left heart catheterization
93510 TC Left heart catheterization
93510 26 Left heart catheterization
99173
Visual acuity screen
99175
Induction of vomiting
99183
Hyperbaric oxygen therapy
99185
Regional hypothermia
99186
Total body hypothermia
99190
Special pump services
99191
Special pump services
99192
Special pump services
99195
Phlebotomy
99199
Special service/proc/report
99201
Office/outpatient visit, new
99202
Office/outpatient visit, new
99203
Office/outpatient visit, new
99204
Office/outpatient visit, new
FULLY
IMPLEMENTEDNON-FAC
FULLY
IMPLEMENTEDFACILITY
IMPLEMENTEDIMPLEMENTED
STATUS MEDICARE
WORK NON-FAC
NA
FACILITY
NA
CODE
RVU
INDICATOR
PE RVU
INDICATOR RVU
A
A
A
N
A
A
A
A
X
X
X
A
C
A
A
A
A
PAYMENT
4.32
0.00
4.32
0.00
0.00
2.34
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.45
0.88
1.34
2.00
PE RVU
39.26
37.08
2.18
0.00
1.40
4.75
0.64
1.79
0.00
0.00
0.00
0.44
0.00
0.50
0.79
1.13
1.51
39.26 NA
37.08 NA
2.18
0.00
1.40 NA
0.72
0.64 NA
1.79 NA
0.00
0.00
0.00
0.44 NA
0.00
0.16
0.32
0.48
0.71
FULLY
MP
2.57
2.30
0.27
0.00
0.10
0.14
0.04
0.45
0.00
0.00
0.00
0.02
0.00
0.02
0.06
0.10
0.12
NON-FACILITYFACILITY
TOTAL
46.15
39.38
6.77
0.00
1.50
7.23
0.68
2.24
0.00
0.00
0.00
0.46
0.00
0.97
1.73
2.57
3.63
TOTAL
46.15
39.38
6.77
0.00
1.50
3.20
0.68
2.24
0.00
0.00
0.00
0.46
0.00
0.63
1.26
1.92
2.83
NOT USED
FULLY
FOR
Impl
NON-FAC
FULLY
Impl
FACILITY
FULLY
FULLY
Imp
Imp
REVISED 2/09/2004
STATUS MEDICARE
WORK
NON-FAC
NA
FACILITY
NA
MP
NON-FAC
FACILITY
HCPCS
CODE
RVU
PE RVU
INDICATOR
PE RVU
INDICATOR
RVU
TOTAL
TOTAL
99281
99282
99283
99284
99285
99288
99289
99290
99291
99292
99293
99294
99295
MOD DESCRIPTION
Emergency dept visit
Emergency dept visit
Emergency dept visit
Emergency dept visit
Emergency dept visit
Direct advanced life support
Ped crit care transport
Ped crit care transport addl
Critical care, first hour
Critical care, add’l 30 min
Ped critical care, initial
Ped critical care, subseq
Neonate crit care, initial
A
A
A
A
A
B
A
A
A
A
A
A
A
PAYMENT
0.33
0.55
1.24
1.95
3.06
0.00
4.79
2.40
3.99
2.00
15.98
7.99
18.46
0.09
0.15
0.31
0.47
0.72
0.00
1.91
0.83
2.34
0.81
4.96
2.49
5.39
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.09
0.15
0.31
0.47
0.72
0.00
1.91
0.83
1.28
0.64
4.96
2.49
5.39
0.02
0.04
0.10
0.14
0.23
0.00
0.17
0.08
0.17
0.08
0.84
0.28
0.84
0.44
0.74
1.65
2.56
4.01
0.00
6.87
3.31
6.50
2.89
21.78
10.76
24.69
0.44
0.74
1.65
2.56
4.01
0.00
6.87
3.31
5.44
2.72
21.78
10.76
24.69
2004 UBU-UBO Conference
But Wait, There is MORE in CMS
FULLY
Imp
REVISED 2/09/2004
STATUS FACILITY
PCTC
GLOB PRE
INTRA POST MULT BILAT ASST
HCPCS
CODE
IND
DAYS OP
OP
0
0
0
0
0
0
0
0
090
090
090
090
090
090
090
090
32445
32480
32482
32484
32486
32488
32491
32500
MOD DESCRIPTION
Removal of lung
Partial removal of lung
Bilobectomy
Segmentectomy
Sleeve lobectomy
Completion pneumonectomy
Lung volume reduction
Partial removal of lung
A
A
A
A
A
A
R
A
TOTAL
42.93
38.53
40.76
35.16
40.80
43.35
37.11
36.50
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.76
0.76
0.76
0.76
0.76
0.76
0.76
0.76
CO-
TEAM ENDO CONV
OP
PROC SURG SURG SURG SURG BASE FACTOR
0.14
0.14
0.14
0.14
0.14
0.14
0.14
0.14
2
2
2
2
2
2
2
2
0
0
0
0
0
0
1
0
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
0
0
0
0
0
0
0
0
37.3374
37.3374
37.3374
37.3374
37.3374
37.3374
37.3374
37.3374
Global RVUs
Provides
time frames that apply to each surgical procedure.
000=Endoscopic
or minor procedure with related preoperative and postoperative
relative values on the day of the procedure only included in the fee schedule
payment amount; evaluation and management services on the day of the procedure
generally not payable.
010=Minor
procedure with preoperative relative values on the day of the procedure
and postoperative relative values during a 10 day postoperative period included in
the fee schedule amount; evaluation and management services on the day of the
procedure and during the 10-day postoperative period generally not payable.
090=Major
surgery with a 1-day preoperative period and 90-day postoperative
period included in the fee schedule amount.

MMM=Maternity
XXX=The
codes; usual global period does not apply.
global concept does not apply to the code.
YYY=The
carrier is to determine whether the global concept applies and
establishes postoperative period, if appropriate, at time of pricing.
ZZZ=The
code is related to another service and is always included in the global
period of the other service.
Procedures – Discountable Surgical Procedures
Multiple procedure column of RVU table
0=No payment adjustment rules for multiple procedures apply.
1=If procedure is reported on the same day as another procedure
that has an indicator of 1, 2, or 3, rank the procedures by fee
schedule amount and apply the appropriate reduction to this
code (100%, 50%, 25%, 25%, 25%, and by report).
2=If procedure is reported on the same day as another procedure
with an indicator of 1, 2, or 3, rank the procedures by fee
schedule amount and apply the appropriate reduction to this
code (100%, 50%, 50%, 50%, 50% and by report).
3=Special rules for multiple endoscopic procedures apply if
procedure is billed with another endoscopy in the same family
9=Concept does not apply.
Multiple procedures - Code the most expensive
first, then code others.
-51 modifier for multiple procedures
45378
Diagnostic colonoscopy
A
45378 53 Diagnostic colonoscopy
A
45379
Colonoscopy w/fb removal A
45380
Colonoscopy and biopsy
A
45381
Colonoscopy, submucous inj A
45382
Colonoscopy/control bleedingA
45383
Lesion removal colonoscopy A
45384
Lesion remove colonoscopy A
45385
Lesion removal colonoscopy A
3.69
0.96
4.68
4.43
4.19
5.68
5.86
4.69
5.30
6.04
2.20
7.56
7.07
8.14
9.72
7.85
6.69
7.69
1.58
0.52
1.86
1.78
1.69
2.23
2.27
1.87
2.08
Collect Work and Hours in the
Same MEPRS
• Public Health technician does STD
education – this is NOT Flight Medicine
(BJAA)
• Audiologist reviews OSHA baseline
screening for civilian working in a shop on
base – this is not Audiology, it is Hearing
Conservation
So What is Up with
Anesthesiology?
• UBU voted to have anesthesiology record
hours and expensed in DFAA
– But to collect the coding on the same SADR
as the surgeon, in the surgeon’s MEPRS
– What does this do?
• Creates a mess for billing
• Doubles the RVUs the surgical clinic receives from
that SADR, even though it is anesthesia doing the
work
• Links the anesthesia services to the surgical
services
Objectives
• Have a Vague Idea of Data Collection and
Measurement Tools
• Had a Look-See of a CMS and MHS RVU
table
• Understand that the Incorrect Application
of Tools will Drive Really Bad Decisions
Quiz
• Guess you noticed this does not match the
slide on the screen – ha ha
• Please fill out comment forms – if you
don’t, I assume you were a happy camper
and I should not change this if requested
to do something similar next year
Registrations/Certifications
• Runs the Department/Office
• RHIA – Registered Health Information Administrator (AHIMA), like a
coach on a football team
• RHIT – Registered Health Information Technician (AHIMA), like a
special teams coach on a football team
• Coders
• CCS- Certified Coding Specialist – really knows inpatient
institutional coding, like a place kicker on a football team (AHIMA)
• CCS-P – Certified Coding Specialist-Professional Services – really
knows professional services coding (doctor’s office coding) (AHIMA)
• CPC – Certified Professional Coder, really knows professional
services coding (doctor’s office coding)(AAPC)
• CPC-H – Certified Professional Coder – Hospital based, really
knows inpatient professional services coding (AAPC)